Aspirin intolerance: does desensitization alter the course of the disease?

Intolerance to acetylsalicylic acid and to other nonsteroidal anti-inflammatory drugs was first described in 1922. The clinical picture reveals a classic triad of symptoms: aspirin-induced bronchial asthma, aspirin sensitivity, and chronic rhinosinusitis with nasal polyps. In many cases, nasal polyps reveal as the first symptom of ASA sensitivity, indicating that the upper airways are predominantly involved in the pathogenetic process. The emphasis of this article is on the upper airways of ASA-intolerant patients. Imbalance of the eicosanoids leukotrienes and prostaglandins might be the pathophysiologic key to the disease. The patient's history and challenge tests with lysine-aspirin are the diagnostic tools of choice. Apart from surgical or pharmacologic therapy, ASA-desensitization therapy is the treatment of choice. Various desensitization protocols and routes of administration are discussed.